Healthcare Provider Details

I. General information

NPI: 1962366245
Provider Name (Legal Business Name): HOMESTEAD HEIGHTS OF NEW BERLIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 HOMESTEAD HEIGHTS DR.
MIFFLINBURG PA
17844
US

IV. Provider business mailing address

PO BOX 144
NEW BERLIN PA
17855-0144
US

V. Phone/Fax

Practice location:
  • Phone: 570-217-0066
  • Fax: 570-209-8845
Mailing address:
  • Phone: 570-217-0066
  • Fax: 570-209-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DAVE WENGERD
Title or Position: ADMINISTRATOR
Credential: ALRA
Phone: 570-217-0066